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Hepatic Transplantation
Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Whole liver allograft (cadaver donor)
          • Orthotopic liver transplantation (OLT)
          • Included from donor
            • Intact inferior vena cava (IVC)
              • Anastomosed end-to-end or as "piggy-back" side-to-side
            • Hepatic artery (HA)
              • Anastomosed end-to-end, sometimes with aortic (Carrel) patch
            • Portal vein (PV)
              • End-to-end anastomosis
            • Bile duct
              • Anastomosed end-to-end with recipient duct (70%) or to Roux limb
        • Cadaver split liver (2 halves to separate recipients)
          • Right lobe to adult recipient (IVC, HA, PV, bile duct)
          • Left lobe to child recipient (complex anastomoses)
        • Living donor transplant
          • Child recipient: Generally receives lateral segment of donor liver
          • Adult recipient: Receives right lobe of donor
          • Complex biliary and vascular anastomoses

      IMAGING

      • Normal Post-Transplantation Findings

        • Pre-Transplantation Evaluation

          • Allograft Rejection

            • Biliary Complications

              • Vascular Complications

                • Recurrent Disease Within Allograft

                  • Extrahepatic Complications

                    CLINICAL ISSUES

                    • Natural History & Prognosis

                      DIAGNOSTIC CHECKLIST

                      • Image Interpretation Pearls

                        Selected References

                        1. Lai Q et al: Hepatocellular cancer: how to expand safely inclusion criteria for liver transplantation. Curr Opin Organ Transplant. 19(3):229-34, 2014
                        2. Song GW et al: Living donor liver transplantation. Curr Opin Organ Transplant. 19(3):217-22, 2014
                        3. Liu YI et al: Multidetector computed tomography triphasic evaluation of the liver before transplantation: importance of equilibrium phase washout and morphology for characterizing hypervascular lesions. J Comput Assist Tomogr. 36(2):213-9, 2012
                        4. Singh AK et al: Imaging of preoperative liver transplantation in adults: what radiologists should know. Radiographics. 31(4):1017-30, 2011
                        5. Miraglia R et al: Interventional radiology procedures in pediatric patients with complications after liver transplantation. Radiographics. 29(2):567-84, 2009
                        6. Chen HL et al: Diagnosis and interventional radiological treatment of vascular and biliary complications after liver transplantation in children with biliary atresia. Transplant Proc. 40(8):2534-6, 2008
                        7. Ko GY et al: Early posttransplant hepatic venous outflow obstruction: Long-term efficacy of primary stent placement. Liver Transpl. 14(10):1505-11, 2008
                        8. Caiado AH et al: Complications of liver transplantation: multimodality imaging approach. Radiographics. 27(5):1401-17, 2007
                        9. Zhang BL et al: Early sonographic assessment of Budd-Chiari syndrome after orthotopic liver transplantation. J Clin Ultrasound. 35(8):458-61, 2007
                        10. Berrocal T et al: Pediatric liver transplantation: a pictorial essay of early and late complications. Radiographics. 26(4):1187-209, 2006
                        11. Nishida S et al: Intrahepatic biliary strictures after liver transplantation. J Hepatobiliary Pancreat Surg. 13(6):511-6, 2006
                        12. Shin JH et al: Endovascular stent placement for interposed middle hepatic vein graft occlusion after living-donor liver transplantation using right-lobe graft. Liver Transpl. 12(2):269-76, 2006
                        13. Thuluvath PJ et al: Biliary complications after liver transplantation: the role of endoscopy. Endoscopy. 37(9):857-63, 2005
                        14. Wang SL et al: Treatment of hepatic venous outflow obstruction after piggyback liver transplantation. Radiology. 236(1):352-9, 2005
                        15. Boraschi P et al: Complications of orthotopic liver transplantation: imaging findings. Abdom Imaging. 29(2):189-202, 2004
                        16. Huang DZ et al: The value of color Doppler ultrasonography in monitoring normal orthotopic liver transplantation and postoperative complications. Hepatobiliary Pancreat Dis Int. 2(1):54-8, 2003
                        17. Ko GY et al: Endovascular treatment of hepatic venous outflow obstruction after living-donor liver transplantation. J Vasc Interv Radiol. 13(6):591-9, 2002
                        18. Cheng YF et al: Interventional radiologic procedures in liver transplantation. Transpl Int. 14(4):223-9, 2001
                        19. Inomata Y et al: Pathogenesis and treatment of bile duct loss after liver transplantation. J Hepatobiliary Pancreat Surg. 8(4):316-22, 2001
                        20. Barton P et al: Biliary sludge after liver transplantation: 2. Treatment with interventional techniques versus surgery and/or oral chemolysis. AJR Am J Roentgenol. 164(4):865-9, 1995
                        Related Anatomy
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                        References
                        Tables

                        Tables

                        KEY FACTS

                        • Terminology

                          • Imaging

                            TERMINOLOGY

                            • Definitions

                              • Whole liver allograft (cadaver donor)
                                • Orthotopic liver transplantation (OLT)
                                • Included from donor
                                  • Intact inferior vena cava (IVC)
                                    • Anastomosed end-to-end or as "piggy-back" side-to-side
                                  • Hepatic artery (HA)
                                    • Anastomosed end-to-end, sometimes with aortic (Carrel) patch
                                  • Portal vein (PV)
                                    • End-to-end anastomosis
                                  • Bile duct
                                    • Anastomosed end-to-end with recipient duct (70%) or to Roux limb
                              • Cadaver split liver (2 halves to separate recipients)
                                • Right lobe to adult recipient (IVC, HA, PV, bile duct)
                                • Left lobe to child recipient (complex anastomoses)
                              • Living donor transplant
                                • Child recipient: Generally receives lateral segment of donor liver
                                • Adult recipient: Receives right lobe of donor
                                • Complex biliary and vascular anastomoses

                            IMAGING

                            • Normal Post-Transplantation Findings

                              • Pre-Transplantation Evaluation

                                • Allograft Rejection

                                  • Biliary Complications

                                    • Vascular Complications

                                      • Recurrent Disease Within Allograft

                                        • Extrahepatic Complications

                                          CLINICAL ISSUES

                                          • Natural History & Prognosis

                                            DIAGNOSTIC CHECKLIST

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Lai Q et al: Hepatocellular cancer: how to expand safely inclusion criteria for liver transplantation. Curr Opin Organ Transplant. 19(3):229-34, 2014
                                              2. Song GW et al: Living donor liver transplantation. Curr Opin Organ Transplant. 19(3):217-22, 2014
                                              3. Liu YI et al: Multidetector computed tomography triphasic evaluation of the liver before transplantation: importance of equilibrium phase washout and morphology for characterizing hypervascular lesions. J Comput Assist Tomogr. 36(2):213-9, 2012
                                              4. Singh AK et al: Imaging of preoperative liver transplantation in adults: what radiologists should know. Radiographics. 31(4):1017-30, 2011
                                              5. Miraglia R et al: Interventional radiology procedures in pediatric patients with complications after liver transplantation. Radiographics. 29(2):567-84, 2009
                                              6. Chen HL et al: Diagnosis and interventional radiological treatment of vascular and biliary complications after liver transplantation in children with biliary atresia. Transplant Proc. 40(8):2534-6, 2008
                                              7. Ko GY et al: Early posttransplant hepatic venous outflow obstruction: Long-term efficacy of primary stent placement. Liver Transpl. 14(10):1505-11, 2008
                                              8. Caiado AH et al: Complications of liver transplantation: multimodality imaging approach. Radiographics. 27(5):1401-17, 2007
                                              9. Zhang BL et al: Early sonographic assessment of Budd-Chiari syndrome after orthotopic liver transplantation. J Clin Ultrasound. 35(8):458-61, 2007
                                              10. Berrocal T et al: Pediatric liver transplantation: a pictorial essay of early and late complications. Radiographics. 26(4):1187-209, 2006
                                              11. Nishida S et al: Intrahepatic biliary strictures after liver transplantation. J Hepatobiliary Pancreat Surg. 13(6):511-6, 2006
                                              12. Shin JH et al: Endovascular stent placement for interposed middle hepatic vein graft occlusion after living-donor liver transplantation using right-lobe graft. Liver Transpl. 12(2):269-76, 2006
                                              13. Thuluvath PJ et al: Biliary complications after liver transplantation: the role of endoscopy. Endoscopy. 37(9):857-63, 2005
                                              14. Wang SL et al: Treatment of hepatic venous outflow obstruction after piggyback liver transplantation. Radiology. 236(1):352-9, 2005
                                              15. Boraschi P et al: Complications of orthotopic liver transplantation: imaging findings. Abdom Imaging. 29(2):189-202, 2004
                                              16. Huang DZ et al: The value of color Doppler ultrasonography in monitoring normal orthotopic liver transplantation and postoperative complications. Hepatobiliary Pancreat Dis Int. 2(1):54-8, 2003
                                              17. Ko GY et al: Endovascular treatment of hepatic venous outflow obstruction after living-donor liver transplantation. J Vasc Interv Radiol. 13(6):591-9, 2002
                                              18. Cheng YF et al: Interventional radiologic procedures in liver transplantation. Transpl Int. 14(4):223-9, 2001
                                              19. Inomata Y et al: Pathogenesis and treatment of bile duct loss after liver transplantation. J Hepatobiliary Pancreat Surg. 8(4):316-22, 2001
                                              20. Barton P et al: Biliary sludge after liver transplantation: 2. Treatment with interventional techniques versus surgery and/or oral chemolysis. AJR Am J Roentgenol. 164(4):865-9, 1995